Adolescent girls and young women (ages 15-24) in sub-Saharan Africa face the dual threats of HIV infection and unintended pregnancy that severely undermine their long-term wellbeing. However, despite the urgent need to reach young women with sexual and reproductive health services, health systems are often ill equipped to overcome the numerous barriers to health care services faced by young women. Our team, including Dr. Jenny Liu (UCSF), Dr. Sue Napierala (RTI International), and Dr. Prosper Njau (Health for a Prosperous Nation), is embarking on a new NIH-funded project to address this need in Tanzania.

We will develop 'girl-friendly' drug shops (known as Accredited Drug Dispensing Outlets, or ADDOs, in Tanzania) as a venue where young women can access HIV prevention services and contraception. The motivation for this approach is the growing recognition that drug shops, which are widely located in urban and rural settings, can promote beneficial health behaviors, bridge gaps in health services, and mitigate health workforce shortages. Similar to our previous projects, we will use human centered design to select and refine the best solutions from behavioral economics to optimize the girl-friendly approach.

We will evaluate these approaches in a pilot study in 20 drug girl-friendly drug shops. We will measure whether there is demand for contraception and HIV self-tests and whether drug shops are a suitable venue for their distribution. We will also provide linkages to local health care providers in case a young woman requires a clinical evaluation (e.g., for HIV infection). Our long term goal is to provide guidance to the government and scientific community about whether community-based distribution of HIV testing at drug shops is an effective strategy for decreasing the incidence of HIV and unintended pregnancies among girls and young women. Read more about the NIH-funded project here.

This week our team traveled to Paris for the 9th International AIDS Society Conference on HIV Science where we presented our latest research findings. Doctoral student Carolyn Fahey presented her work on the effects of short-term cash and food assistance on food insecurity and labor force participation among HIV-infected adults in Tanzania (watch her presentation here and see her abstract #TUAD0204 in the abstract book). Recent MPH graduate Jillian Kadota presented an analysis that found that cash transfers do not increase the use of temptation goods like alcohol, a reassuring finding consistent with prior literature on cash transfers. She also presented an analysis which found that cash and food transfers work the best among those who were recently initiated on antiretroviral therapy and among the poorest patients, which may be related to the cost of transportation to the clinic. These data can be used to better design future cash transfer programs for people living with HIV infection in Tanzania and elsewhere. Lastly, we presented the results of our study that used human-centered design to develop an intervention using social norms and priming to improve adherence to antiretroviral therapy and retention in care among adults with HIV in Tanzania (watch the presentation here and read about the full study in PLoS One). We also published a two-part series on this study in the Stanford Social Innovation Review (see Part I and Part II). A very successful week for our research team and we are enthusiastic about incorporating the new ideas and perspectives we learned in Paris into our future work.

This fictional persona represents a typical patient that belongs to the Courageous Fighter segment. Positive reinforcement and social support motivate these patients to adhere, despite the obstacles they face. See other personas and the accompanying "customer journeys" here.

We are very pleased that our innovative research using patient-centered design and behavioral priming was featured in the Stanford Social Innovation Review over the summer. In an article led by Aarthi Rao, we describe how a patient-centered approach together with tools from the private sector can greatly enhance global health programs that require changes in attitudes or behavior. We apply this strategy to the problem of antiretroviral therapy adherence among HIV-infected adults in Tanzania. The patient personas and customer journeys featured in the article can be found here.